Tag Archives: patient family

In the psychotherapeutic treatment of adult survivors of Child Sexual Abuse (CSA) therapists are often mistaken in treating the survivor in isolation and fail to include in their therapy, the role of the partner in their couple relationship. This is to limit and detract from the therapy on offer as “If, as we can all agree, healing takes place in moments of secure attachment (Solomon, 2003) then the opportunity provided for healing within the current couple relationship is a vital and dynamic opportunity that ought not be overlooked” (Quinlan, 2013).

In my practice at Midwest Counselling I too have found it common that adult survivors of CSA seek out and replicate the trauma of their abuse (Briere & Scott, 2006). Attachment theory, (Bowlby, 1988) may account for why in some cases the “normal” attachment processes formed in early childhood are replaced in adulthood by this re-enactment of disruptive relationships, and may even lead to re-enactment of traumatisation (Allen, 2001). Because of unresolved issues arising as a result of the CSA, such as fractured impressions of how adult sexual relationships are supposed to work, or errant self-images as a result of childhood programming, then often the adult generalised view is fractured and errant. For instance they may view all physical contact as frightening, painful or abusive, or that all men/women are inherently dangerous. It follows then that these views shadow them into their adult couple relationships.

Subsequently then in treating adult survivors of CSA, the circularity of systemic family therapy may also be helpful. As mentioned in Coping with Child Sexual Abuse in Adult relationships, Part I, in couple relationships, it is commonly found that the partner of the survivor of CSA is bringing with them their own problems of equal measure. Therefore, as the therapy investigates the paradigm that exists between the couple, a pattern of co-dependant coping strategies may emerge. This iterates the importance of treating the client in a holistic way, and of looking at more than just the trauma of the CSA but also at the extended influence this is having on their couple relationships. So too, the benefit to couples counselling is massive, it can help raise a number of questions that could facilitate to a great extent the investigation into the nature of the couple relationship that exists that is been brought to couple therapy for “fixing”.

Given the aforementioned propensity for adult survivors of CSA to seek out and form relationships that emulate patterns and elements of the original abuse, then the benefit of including the partner in therapy is inherent. By engaging with both partners the therapist can work on limiting the re-enactments and re-traumatisation of the client. Furthermore and equally as importantly by soliciting the participation of the clients partner, the therapist can encourage and facilitate the growth of understanding and respect, and the identification of mutually beneficial goals that may ultimately lead to a constructive and nourishing adult relationship.

Mental health describes a level of psychological well-being, or an absence of a mental disorder.[1][2] From the perspective of ‘positive psychology‘ or ‘holism‘, mental health may include an individual’s ability to enjoy life, and create a balance between life activities and efforts to achieve psychological resilience.[1] Mental health can also be defined as an expression of emotions, and as signifying a successful adaptation to a range of demands.

Low self-esteem

Low self-esteem can result from various factors, including a physical appearance or weight, socioeconomic status, or peer pressure or bullying.

Low self-esteem occasionally leads to suicidal ideation and behaviour. These can include self-imposed isolation, feelings of rejection, dejection, insignificance, and detachment, and increased dissatisfaction with current social relationships. A lack of social support from peers or family tends to create or exacerbate stress on an individual, which can lead to an inability to adjust to current circumstances. Drug abuse and forms of delinquency are common side effects of low self-esteem.

A person with low self-esteem may show some of the following characteristics:

Heavy self-criticism and dissatisfaction.

Hypersensitivity to criticism with resentment against critics and feelings of being attacked.

Chronic indecision and an exaggerated fear of mistakes.

Excessive will to please and unwillingness to displease any petitioner.

Perfectionism, which can lead to frustration when perfection is not achieved.

Neurotic guilt, dwelling on and exaggerating the magnitude of past mistakes.

Floating hostility and general defensiveness and irritability without any proximate cause.

Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client, patient, family, couple, or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend on the specialty of the practitioner.